title: The predictive value of heart-type fatty acid-binding protein is independent from symptom duration in normotensive patients with pulmonary embolism.
abstract: BACKGROUND
  Heart-type fatty acid-binding protein (H-FABP) is a useful biomarker for risk stratification of patients with pulmonary embolism (PE). In patients with acute myocardial infarction, H-FABP plasma concentrations rise after 30 minutes and return to normal within 20-24 hours. We tested whether the predictive value of H-FABP is affected by the duration of symptoms prior to diagnosis in patients with PE.
  
  
  METHODS
  We prospectively studied 257 consecutive normotensive patients with confirmed symptomatic PE.
  
  
  RESULTS
  Patients with acute (<24 hours; n=150) symptom onset presented more often with syncope (28.7% vs. 6.5%; p<0.001) compared to patients with symptoms ≥ 24 hours (n=107); other baseline characteristics, comorbidities, and risk factors were distributed equally. Patients with an adverse 30-day outcome (6.6%) had higher H-FABP levels (11.84 [3.57-19.62] ng/ml) compared to patients with a favorable course (3.42 [1.92-5.42] ng/ml; p<0.001). However, the proportion of patients with H-FABP levels ≥ 6 ng/ml did not differ among patients with acute symptom onset and late presentation (p=0.104). Only tachycardia and elevation of H-FABP were associated with an increased risk of an adverse 30-day outcome both in patients with acute symptom onset (H-FABP: OR, 5.8; 95% CI, 1.4-24.5; p=0.016; tachycardia: 7.0 [1.4-36.0]; p=0.018) and late presentation (H-FABP: 9.3 [2.0-43.2]; p=0.004 and tachycardia: 12.3 [1.5-103.6]; p=0.021). The prognostic value could further be improved by the use of a simple H-FABP-based clinical prediction score.
  
  
  CONCLUSIONS
  Our findings indicate that H-FABP is a useful biomarker for risk stratification of normotensive patients with PE regardless of symptom duration prior to diagnosis.
authors.affiliation: Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Johannes Gutenberg University of Mainz, Germany; Department of Cardiology and Pulmonology, Heart Center of the Georg August University of Göttingen, Germany. Electronic address: mareike.lankeit@unimedizin-mainz.de.
authors.forename: Mareike
authors.initials: M
authors.lastname: Lankeit
authors.forename: Claudia
authors.initials: C
authors.lastname: Dellas
authors.forename: Viola
authors.initials: V
authors.lastname: Benz
authors.forename: Gerd
authors.initials: G
authors.lastname: Hasenfuß
authors.forename: Stavros
authors.initials: S
authors.lastname: Konstantinides
mesh_terms: D000368:Aged; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000097:blood* / Q000175:diagnosis*
chemical_list: C493408:FABP3 protein, human; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins
keywords: AUC; Biomarker; CI; ELISA; FAST score; GFR; H-FABP; H-FABP, syncope, and tachycardia; Heart-type fatty acid-binding protein; Kinetics; N-terminal pro-brain natriuretic peptide; NT-proBNP; OR; PE; Prognosis; Pulmonary embolism; ROC; RV; Risk stratification; area under the curve; cTnI/T; cardiac troponin I/T; confidence interval; enzyme-linked immunosorbent assay; glomerular filtration rate; heart-type fatty acid-binding protein; odds ratio; pulmonary embolism; receiver operating characteristic; right ventricular